The seventh annual report from the National Registry of Deliberate Self Harm was published in July 2009.1 The report contains information relating to every presentation of deliberate self-harm to hospital A&E departments in 2008, giving complete national coverage of hospital-treated deliberate self-harm. The Registry defines deliberate self-harm as ‘an act with non-fatal outcome in which an individual deliberately initiates a non-habitual behaviour, that without intervention from others will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes that the person desires via the actual or physical consequences’.

According to the report, there were 11,700 presentations of deliberate self-harm, involving 9,218 individuals, to A&E departments in 2008. Reviewing data for the six-year period 2002–2007, the report indicates that the rate of presentation was relatively stable. However, a 6% increase was noted in the national person-based rate per 100,000, which rose from 188 in 2007 to 200 in 2008.

The biggest rise in deliberate self-harm was observed in men, an increase of 11% on the 2007 figure, resulting in the highest rate since the Registry was established in 2002. Men accounted for 45% and women for 55% of deliberate self harm episodes in 2008.

Concordant with previous reports, deliberate self-harm was largely confined to the younger age groups. Almost half of all presentations (46.5%) were by people aged under 30 years. The peak age ranges for females and males presenting were the same as in previous years, at 15–19 years for females and 20–24 years for males. There was an increase in the number of 10–14-year-olds presenting.

Rates were higher in urban settings, with the highest rate (17%) presented in Dublin North East Hospital Group. The number of presentations was highest on Mondays and Sundays, accounting for one in three of all presentations. Over 40% of all presentations were made between the hours of 8 pm and 3 am.

Repetition of deliberate self-harm accounted for more than one in five (21%) of all presentations in 2008, and the highest proportion of repeated acts was among the 30–40-year age group.

Drug overdose was the most common form of deliberate self-harm, representing 72% of all such episodes reported in 2008. Overdose rates were higher among females (79%) than among males (64%).On average, at least 31 tablets were taken in episodes of drug overdose. The total number of tablets taken was known in 74% of cases. Forty-one per cent of all drug overdoses involved a minor tranquilliser,23% involved paracetamol-containing medicines and 22% involved anti-depressants/mood stabilisers. The report points out that, despite its withdrawal from the Irish market in January 2005, the analgesia, distalgesic, was involved in 29 cases of deliberate self-harm in 2008, this compared to approximately four hundred cases reported annually between 2002 and 2005.

There was evidence of alcohol consumption in 42% of all episodes of deliberate self-harm, emphasising the strong association between alcohol consumption and suicidal behaviour. Illicit drugs such as cocaine and heroin were involved in 3.8% of all overdose acts.

Attempted hanging was more often used as a method of deliberate self-harm in 2008 than in previous years, accounting for 16% of all self-harm acts in the 10–14-year age group. Self-cutting represented 21% of all episodes of self-harm, and was more common among males (25%) than among females (18%).

The emergency department was the only treatment setting for more than half (57%) of all deliberate self-harm patients, that is, they did not proceed to further treatment.

The report recommends the following measures to reduce the incidence of deliberate self-harm:

Provide continued support for the national mental health awareness campaign and evidence-based mental health promotion initiatives and implementing more intensified prevention and intervention programmes at national level.

Develop and implement initiatives to increase awareness of mental health issues among the general public and service providers supporting the unemployed or people experiencing financial difficulties.

Develop a system to enable deliberate self-harm data to be linked with suicide mortality data to improve our understanding of risk factors associated with suicide.

Prioritise evidence-based mental health programmes for children and adolescents, in addition to specialist mental health services.

Develop more uniform assessment procedures and evidence-based interventions targeting people who repeatedly self-harm.

Restrict or withdraw highly lethal drugs from the market.

Verify whether interventions such as cognitive behavioural and problem-solving treatments found to be effective among women can be equally so among men presenting with deliberate self-harm.